A Randomised Comparison of Bicalutamide (‘Casodex’) 150 mg versus Placebo as Immediate Therapy Either Alone or as Adjuvant to Standard Care for Early Non-Metastatic Prostate Cancer: First Report from the Scandinavian Prostatic Cancer Group Study No. 6
Abstract
Objectives: To assess the efficacy and tolerability of bicalutamide 150 mg (‘Casodex’1) as immediate therapy, either alone or as adjuvant to treatment of curative intent, in patients with early (T1b–T4, any N, M0) prostate cancer.
Methods: This randomised, double-blind study was conducted in the Nordic countries as part of the ‘Casodex’ Early Prostate Cancer programme. Patients received bicalutamide 150 mg (n=607) or placebo (n=611) in addition to standard care.
Results: More than 80% of patients had not received therapy of primary curative intent. Median follow-up in both groups was 3 years. Median exposure to study treatment in the bicalutamide and standard care alone groups was 2.5 and 2.3 years, respectively. Bicalutamide reduced the risk of objective disease progression by 57% compared with standard care alone (HR 0.43; 95% CI 0.34, 0.55; p⪡0.0001). Survival data were immature (11.4% deaths) with no difference between the two treatment groups.
Conclusions: Bicalutamide 150 mg as immediate therapy, either alone or as adjuvant to treatment of curative intent, significantly reduces the risk of disease progression in patients with early prostate cancer. The trial is ongoing to assess whether the reduction in risk of objective progression translates into an overall survival benefit.
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David2703
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In an earlier post, you wrote that you were surgically castrated. Why are you taking Casodex?
You understand that the study you are quoting is from 2002, and compares Casodex to placebo (not castration)? Since then, we have a number of second-line hormonal medications that work a LOT better than Casodex.
ADT (or castration) + casodex is common. It is true that abi in particular is a lot more powerful than casodex. But you can do abi after casodex. Win Win
You are right kaptank. Abi and Bicalutamide have totally different mechanism of action.Abi works by blocking testosterone at all three sites of production viz. testicles, adrenals and cancer cells themselves. In fact, Abi is a form of ADT because all it does is reduces testosterone further ...even lower than Lupron type meds. Its an extended ADT. Abi has a lot of serious side effects compared to Bicalutamide.
Bicalutamide is a LUTAMIDE...which does not reduce testosterone . It blocks the effect of testosterone even if T is circulating full in your blood..lutamides can not let it do harm.
Bicalutamide (casodex) is just like newer lutamides like Enzalutamide (extandi) ,Apalutamide, Darolutamide etc. The sales men want you use newer lutamides and not the cheapest lutamide like Bicalutamide which is dirt cheap and has least side effects. I am on Bicalutamide 50 mg a day and loving it. If and when..Bicalutamide stops working, I plan to stop Bicalutamide for 1-2 weeks and then, raise dose up until 200 mg a day and then ,if needed ..consider any other options...may be going back to lupron as Intermittent therapy.
I did not mention cross resistance, I mentioned the worse results of waiting to use Zytiga. Bicalutamide is easily used as fuel for the cancer. No one uses it in the way you describe.
Why are you spreading falsehoods that affect peoples' treatment decisions? Firstly bical only promotes PCa after failure. Secondly I was actually in that situation of taking bical first. I consulted a well respected uro who referred me (separately) to 2 of the most respected oncos here in Australia. Both professors in their respective and highly respected institutions, Both the leaders of their own PCa research group. All 3 assured me that taking bical first does not affect future response to abi. Full stop.
Australia has its own Pharmaceutical Benefits Scheme to ensure no one has to pay more than about $30 per month for expensive meds like abi. It requires patients with low PSA and low tumour load to take bical first before abi can be prescribed.. The exceptions are ab initio patients with high PSA and high tumour load - they can do abi straight away. So the whole of Australia uses it the way I describe. This also is something required by our own Therapeutic Goods Administration, the rough equivalent to your FDA.
By the way, talk of "fuel for cancer" simply shows an appalling ignorance of what we now know and have known for 2 decades or so. But you know all that.
Everything I write has evidence - can you say the same? Yes, Casodex is known to promote PC when it fails, which is sooner than other hormonal therapies.
I don't see how these doctors, who you seem to admire, can make such assurances without evidence. Perhaps your admiration is misplaced, or, more likely, perhaps you are inaccurately reporting it.
I doubt the situation in Australia is as you describe. It is not like that anywhere in the North America or Europe. I've talked to several Aussies who were newly diagnosed as metastatic with low tumor load who began with abiraterone. Do you have a reference? I doubt it. You seem fond of making things up.
You seem to be profoundly ignorant of the fact that there are androgen receptors that are indeed, fueled by (guess what?) androgens.
Tellingly, you never cite references. I guess you don't want to let mere facts get in your way.
Europe routinely uses bicalutamide for less advanced cases. As to Australia I write from direct experience. You will find it all (with references) in my profile.
From what I see very little you write has real evidence on close examination. Too much is cobbled together, massaged and irrelevant to what you claim is a conclusion. Your accounts of BAT and TRT I cite in evidence. It is loudly and discourteously asserted opinion. Certainly on matters of which I have experience and knowledge you are often wrong and then go on to further mislead in the face of facts, spewing personal insult as you go.
I see no point in continuing what you have turned into a vapid, ignorant and insulting discussion.
Still, not one actual scientific citation, or even governmental guideline. You have a rich fantasy life. You have no business making absurd claims on a forum where patients are coming for actual help. Shame on you.
I just stumbled on this post.. I just want to report that I had 150 Mg daily of bicalutamide and it kept my PSA to 1 or below for 6 1/2 years before it started to rise. The only side effect I had was it gave me "man boobs".. So I suggest go for it and see what happens.. I was glad to have an Onco here in the states that was able to think outside the box.. She (Dr. Nancy Davis) moved on to Vanderbilt U. & I sure miss her.. My present Onco's are stuck on SOC via the NCCN guidelines & won't budge from them a bit.. Frustates me terribly.. Good luckl..
started with 50 mg casodex as a mono therapy, that worked about two years and then I went to 150 mg of casodex, that worked for 2 more years.I then started the estrogen patch to lower my testosterone.
stopped the casodex, PSA started Rising so I went back to 50 milligrams of casodex, working so far
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